Advertisement
Original article| Volume 16, ISSUE 1, P15-24, January 1992

High resolution computed tomography of inflation-fixed lungs: Pathologic—radiologic correlation of pulmonary lesions in patients with leukemia, lymphoma, or other hematopoietic proliferative disorders

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      The accuracy of high resolution computed tomography (HRCT) in the diagnosis of pulmonary lesions arising in patients with leukemia, lymphoma, or other hematopoietic proliferative disorders was evaluated in postmortem lung specimens from 35 patients with one of these neoplasms. Lungs were obtained from autopsied patients and prepared in a manner that allowed for direct pathologic-radiologic correlation. Eighty-eight pulmonary lesions with one of five radiographic patterns were identified in these 35 lungs. The gross, histologic, and radiographic changes were examined and the radiologic and pathologic diagnoses for each lesion were compared. A diffuse alveolar pattern on HRCT was primarily the result of pneumonia or intraalveolar hemorrhage, while irregular focal densities were produced by foci of hemorrhage, infarcts, lymphoma, and fungal infections. HRCT of the lung from a patient with pulmonary histiocytosis X showed a wedge-shaped subpleural density in association with a “crab-like” interstitial pattern, which was histologically shown to be an infarct with interstitial enlargement by infiltration of histiocytosis X. Air bronchograms were seen in two settings. In patients with necrotizing pneumonia, air bronchograms were associated with bronchiectasis. In contrast, air bronchograms seen in a patient with a bronchocentric lymph oproliferative disorder showed a pattern of bronchial constriction. These results suggest that HRCT may play an important role in the evaluation of pulmonary lesions in patients with leukemia, lymphoma, or other hematopoietic malignancies.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Neiman P.E.
        • Reeves W.
        • Ray G.
        • et al.
        A prospective analysis of interstitial pneumonia and opportunistic viral infection among recipients of allogeneic bone marrow grafts.
        J Infect Dis. 1977; 136: 754-767
        • Khouri N.F.
        • Saral R.
        • Armstrong E.M.
        • et al.
        Pulmonary interstitial changes following bone marrow transplantation: A complex, multifactor disorder.
        Radiology. 1979; 133: 587-592
        • Schaner E.G.
        • Chang A.E.
        • Doppman J.L.
        • Conkle D.M.
        • Flye M.W.
        • Rosenberg S.A.
        Comparison of computed and conventional whole lung tomography in detecting pulmonary nodules: A prospective radiologic-pathologic study.
        Am J Roentgenol. 1978; 131: 51-54
        • Muhm J.R.
        • Brown L.R.
        • Crowe J.K.
        Detection of pulmonary nodules by computed tomography.
        Am J Roentgenol. 1977; 128: 267-270
        • Muhm J.R.
        • Brown L.R.
        • Crowe J.K.
        • Sheedy II, P.F.
        • Hattery R.R.
        • Stephens D.H.
        Comparison of whole lung tomography and computed tomography for detecting pulmonary nodules.
        Am J Roentgenol. 1978; 131: 981-984
        • McLoud T.C.
        • Wittenberg J.
        • Ferrucci Jr., I.T.
        Computed tomography of the thorax and standard radiographic evaluation of the chest: A comparative study.
        J Comput Assist Tomogr. 1979; 3: 170-180
        • Mintzer R.A.
        • Malave S.R.
        • Neiman H.L.
        • Michaelis L.L.
        • Vanecko R.M.
        • Sanders J.H.
        Computed vs. conventional tomography in evaluation of primary and secondary pulmonary neoplasms.
        Radiology. 1979; 132: 653-659
        • Gross B.H.
        • Glazer G.M.
        • Bookstein F.L.
        Multiple pulmonary nodules detected by computed tomography: Diagnostic implications.
        J Comput Assist Tomogr. 1985; 9: 880-885
        • Sills B.
        A multidisciplinary method for study of lung structure and function.
        Am Rev Respir Dis. 1962; 86: 238-245
        • Markarian B.
        • Dailey E.T.
        Preparation of Inflated Lung Specimens.
        in: Heitzman E.R. The Lung: Radiologic-Pathologic Correlations. second edition. C. V. Mosby, St. Louis1984: 4-12
        • Meziane M.A.
        • Hruban R.H.
        • Zerhouni E.A.
        • et al.
        High resolution CT of the lung parenchyma with pathologic correlation.
        Radiographics. 1988; 8: 27-54
        • Kuhlman J.E.
        • Fishman E.K.
        • Siegelman S.S.
        Invasive pulmonary aspergillosis in acute leukemia: Characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis.
        Radiology. 1985; 157: 611-614
        • Hruban R.H.
        • Meziane M.A.
        • Zerhouni E.A.
        • Wheeler P.S.
        • Dumler I.S.
        • Hutchins G.M.
        Radiologic-pathologic correlation of the CT halo sign in invasive pulmonary aspergillosis.
        J Comput Assist Tomogr. 1987; 11: 534-536
        • Kuhlman J.E.
        • Fishman E.K.
        • Burch P.A.
        • Karp J.E.
        • Zerhouni E.A.
        • Siegelman S.S.
        Invasive pulmonary aspergillosis in acute leukemia. The contribution of CT to early diagnosis and aggressive management.
        Chest. 1987; 92: 95-99
        • Lee J.Y.
        • Shank B.
        • Bonfiglio P.
        • Reid A.
        CT analysis of lung density changes in patients undergoing total body irradiation prior to bone marrow transplantation.
        J Comput Assist Tomogr. 1984; 8: 885-891
        • El-Khatib E.E.
        • Freeman C.R.
        • Rybka W.B.
        • Lehnert S.
        • Podgorsak E.B.
        The use of CT densitometry to predict lung toxicity in bone marrow transplant patients.
        Int J Radiat Oncol Biol Phys. 1989; 16: 85-94
        • Hayhurst M.D.
        • Flenley D.C.
        • McLean A.
        • et al.
        Diagnosis of pulmonary emphysema by computerized tomography.
        Lancet. 1984; 2: 320-322
        • Sinner W.N.
        Computed tomographic patterns of pulmonary thromboembolism and infarction.
        J Comput Assist Tomogr. 1978; 2: 395-399
        • Ellert J.
        • Kreel L.
        The role, of computed tomography in the initial staging and subsequent management of the lymphomas.
        J Comput Assist Tomogr. 1980; 4: 368-391
        • Peuchot M.
        • Libshitz H.I.
        Pulmonary metastatic disease: Radiologic-surgical correlation.
        Radiology. 1987; 164: 719-722
        • Hruban R.H.
        • Meziane M.A.
        • Zerhouni E.A.
        • et al.
        High resolution computed tomography of inflation-fixed lungs: Pathologic-radiologic correlation of centrilobular emphysema.
        Am Rev Respir Dis. 1987; 136: 935-940
        • Ren H.
        • Hruban R.H.
        • Kuhlman J.E.
        • et al.
        Computed tomography of inflation-fixed lungs: The beaded-septum sign of pulmonary metastases.
        J Comput Assist Tomogr. 1989; 13: 411-416
        • Ren H.
        • Hruban R.H.
        • Kuhlman J.E.
        • et al.
        Computed tomography of rounded atelectasis.
        J Comput Assist Tomogr. 1988; 12: 1031-1034
        • Ren H.
        • Kuhlman J.E.
        • Hruban R.H.
        • Fishman E.K.
        • Wheeler P.S.
        • Hutchins G.M.
        CT of inflation-fixed lungs: Wedge-shaped density and vascular sign in the diagnosis of infarction.
        J Comput Assist Tomogr. 1990; 14: 82-86
        • Hruban R.H.
        • Ren H.
        • Kuhlman J.E.
        • et al.
        Inflation-fixed lungs: Pathologic-radiologic (CT) correlation of lung transplantation.
        J Comput Assist Tomogr. 1990; 14: 329-335
        • Ren H.
        • Lee D.R.
        • Hruban R.H.
        • et al.
        Pleural plaques do not predict asbestosis: High-resolution computed tomography and pathologic study.
        Mod Pathol. 1991; 4: 201-209
        • Moore A.D.A.
        • Godwin J.D.
        • Müller N.L.
        • et al.
        Pulmonary histiocytosis X: Comparison of radiographic and CT findings.
        Radiology. 1989; 172: 249-254
        • Brauner M.W.
        • Grenier P.
        • Mouelhi M.M.
        • Mompoint D.
        • Lenoir S.
        Pulmonary histiocytosis X: Evaluation with high-resolution CT.
        Radiology. 1989; 172: 255-258
        • Currie D.C.
        • Cooke J.C.
        • Morgan A.D.
        • et al.
        Interpretation of bronchograms and chest radiographs in patients with chronic sputum production.
        Thorax. 1987; 42: 278-284
        • Webb W.R.
        • Gamsu G.
        • Glazer G.
        Computed tomography of the abnormal pulmonary hilum.
        J Comput Assist Tomogr. 1981; 5: 485-490